A client with Parkinson disease asks the nurse why dopamine is not given as a neurotransmitter replacement. Which response by the nurse is the most appropriate?
1. "The risk for hypertension is too high with dopamine; therefore, more frequent cardiac monitoring would be required."
2. "Exogenous dopamine cannot cross the blood–brain barrier and would be of little use."
3. "Exogenous dopamine must be administered via intravenous infusion, which usually requires a central line and continuous cardiac monitoring."
4. "In older clients, the effects of dopamine on urinary function can pose an unacceptable risk for renal failure."
Correct Answer: 2
Rationale 1: This is not the reason dopamine is not given to a client with Parkinson disease. Dopamine can be given to raise blood pressure.
Rationale 2: Dopamine does not cross the blood–brain barrier. Levodopa is the precursor of dopamine and does cross the blood–brain barrier, where the enzyme dopa decarboxylase converts it to dopamine.
Rationale 3: Dopamine is only given intravenously, but that is not the reason it is not prescribed for clients with Parkinson disease.
Rationale 4: Dopamine receptors are located in the kidney, although improvement in renal function is based on dopamine's effect on increasing cardiac output. This is not the reason dopamine is not given to a client with Parkinson disease.
Global Rationale: Dopamine does not cross the blood–brain barrier. Levodopa is the precursor of dopamine and does cross the blood–brain barrier, where the enzyme dopa decarboxylase converts it to dopamine. Dopamine can be given to raise blood pressure, but this is not the reason dopamine is not given to a client with Parkinson disease. Dopamine is only given intravenously, but that is not the reason it is not prescribed for clients with Parkinson disease. Dopamine receptors are located in the kidney, although improvement in renal function is based on dopamine's effect on increasing cardiac output. This is not the reason dopamine is not given to a client with Parkinson disease.
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